Provider First Line Business Practice Location Address:
1450 ALDER RD
Provider Second Line Business Practice Location Address:
BOX 339500
Provider Business Practice Location Address City Name:
JOINT BASE LEWIS-MCCHORD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98433-9500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-966-8357
Provider Business Practice Location Address Fax Number:
253-968-3349
Provider Enumeration Date:
08/23/2007